Nurses + Informatics = A More Streamlined Healthcare System
To understand more about nurse-led efforts and impact during the pandemic, including the use of informatics and beyond, Johnson & Johnson partnered with the American Nurses Association (ANA) and the American Organization for Nursing Leadership (AONL) to lead quantitative and qualitative research, called Accelerating Nursing, Transforming Healthcare (ANTH). We first conducted quantitative research (n=4000), and then went deeper on key topics by interviewing 33 notable nurse leaders and nurse advocates across the country. Our objective was to gain their perspectives on how nurses innovated during the pandemic, along with specific exemplars, to determine how these changes can be continued or expanded to sustain the progress made during the COVID-19 response.
An important learning from the research was how informatics paired with nursing can be leveraged across several facets within health organizations: mapping workflow and care plans, implementing new staffing models, and even reducing administrative burden on nurses. There are additional learnings in our second ANTH chapter on Organizational Structure, and we encourage you to dive in. In the meantime, here are a few examples from the research that highlight how data can support the nursing workforce and enhance care delivery to patients.
Data can reduce the administrative burden of documentation, while supporting nurse-led care
Documentation is a critical part of healthcare—it captures details of patients’ histories and the care they receive, and it supports value-based care, including nursing care, by gathering evidence of essential elements, like patient assessments, teaching, care planning, quality, and even billing. However, as many in the nursing workforce know, documentation can be a huge administrative burden, since it drains time from other important endeavors, like direct patient care, interacting with families, and the “thinking time” that can spur innovation of new methods and models. Additionally, administrative burden is a leading cause of nurse burnout, which has risen precipitously during the pandemic. So, there’s a delicate balance to navigate: Data is vital, but there need to be efficient ways of capturing relevant information so as to not overburden nurses or pull them away from important work.
This is where smart data solutions can come in. One of our 33 ANTH participants, Emily Barey, MSN, Vice President for Nursing at Epic Systems, underlined how informatics can help relieve the double-edged sword of documentation and achieve the right balance between enough and too much. “Documentation was a burden long before the pandemic and only exacerbated by the pandemic,” she said. “But it also gave us a silver lining opportunity to look at essential data sets and critical paths to documentation for safe, effective care.” Ms. Barey said that while pre-pandemic levels of documentation could be excessive, the current, stripped-down version is also insufficient, since it doesn’t collect enough data to capture issues related to “quality, billing, and research, and all the elements need to tell the patient story a bit more completely, when thinking about handoffs, for example,” she said. “So, there is a happy medium in there that we need to consider.”
Developing a good documentation model, Ms. Barey added, can be a joint effort between health system leadership, nurses, and nursing informatics. “Documentation can in part be alleviated through collaboration. Even if you have nursing informatics, operations, IT leading the way, you are still documenting in part to support interdisciplinary team-based care – it is critical to meet the information needs of the downstream reader such as physicians, therapists, case managers and fellow nurses. As such, you replicate the nursing process but with an informatics and technology lens.” In other words, a team-based approach can build a documentation model that takes into account the needs of all stakeholders, alleviating the time pressure on nurses while capturing important patient data.
Informatics will remain critical as nurses continue to lead new strategies for delivering safe and effective care in the coming years—and it will help demonstrate the value of nurse-led care. “Informatics will help illustrate the case with data and information that nurses bring value,” said Ms. Barey. “And informatics will both be an enabler for nurses to contribute to value and integral to measuring the effectiveness. There’s been an explosion of telehealth, virtual hospital, home and community-based care, and nurses are leading the way. It will require informatics to optimize how we work differently in these models, measure our contribution to care and discern the essential data required to do that, while avoiding documentation burden.” The pandemic clearly accelerated the importance and role of informatics, and will be essential in our evolving approach to healthcare moving forward.
Data can streamline staffing, reduce overtime, and build out virtual care
Nurses are critical staff members across the continuum, from in-patient to home to virtual care. But nurse staffing has been an ongoing challenge in healthcare, heightened during the pandemic, as nurses have been in such high demand. Informatics can help develop efficient, flexible, data-driven staffing models to help relieve overwork, balance staffing needs, and ensure nurses are better matched to patient care needs and locations.
Some of our ANTH research participants called for updating outdated productivity and staffing studies and putting into practice more dynamic, informatics-based models that adapt to changing needs. Kathleen Sanford, DBA, RN, FAAN, FACHE, Executive Vice President and Chief Nursing Officer of CommonSpirit Health, which has used and piloted virtual care programs extensively over the years, discussed the fact that predictive modeling can assess charts or electronic medical records (EMR) to model care and help shift systems from the mentality of “what we can afford” to “what is needed,” which improves not only patient care, but nurses’ schedules, too.
“There are systems where you can tell from your charting how sick the patient is and how much care they need—predictive modeling,” said Dr. Sanford. “You just have to be able to redo that predictive modeling on a regular basis, because as technology changes or care models change, the predictive modeling is going to change.” She added that current models that use ratios or older, non-dynamic information ultimately don’t serve the patient well—or the nursing workforce. “I don’t think we can go back to strict productivity,” she said. “We have to figure out something new and different about how you take care of patients that’s not based on ratios or old productivity standards. Ratios are not good for patients, because it doesn't allow us to create new models—and that makes it not good for nurses either.”
Informatics-based staffing models will also support staffing as care shifts more directly into communities and can accommodate the fact that more and more nurses may see their patients remotely in the future. CommonSpirit Health was already heavily invested in virtual care, but during the pandemic launched pilot programs that set up virtual transfer centers and virtual nursing centers. This is part of a larger trend in healthcare—and Dr. Sanford pointed out that as it continues, there will be more specialization in virtual nursing, with some nurses seeing all their patients remotely, which will require even greater reliance on informatics, to accommodate the different locations of patients and nurses themselves.
Enhancing patient care and improving health equity
The pandemic transformed care in many ways, but it also shined a light on gaps in care and inequities in health. Health system data is increasingly instrumental in filling these gaps—including improving patient care and health equity.
The not-so-easy trick is to transform vast amounts of incoming information into something informative and usable. “The nursing model is that data collected derives information, information collectively produces knowledge, and then knowledge applied yields wisdom,” said Ms. Barey. “This cycle repeated itself every day during the pandemic as nurses determined best practices for turning ventilated ICU patients, identified strategies for reducing PPE while still administering medications safely and maintaining close monitoring, and effectively delivering care through telehealth. You needed to quickly be able to put a process to those changes. It’s one thing to decide that not all COVID-positive patients will be admitted and some will be remotely monitored at home, or that others will be discharged to a field hospital, but it is another thing to actually develop a highly reliable and safe workflow, map the handoffs, determine what technology could help, train clinicians and measure the impact.”
Health systems can leverage informatics in many ways, but it generally involves combining existing assets with EMR, staffing and other data sources to make fast, real-time decisions for patients. Virtual hospitals, for instance, can offer remote monitoring to patients with both acute and chronic conditions, as the system can silently assess past and present data and flag changes in the patient’s status or needs. Informatics can also help provide care to patients who have different language needs, who are hearing-impaired, who require specialists not available in their areas, who are at risk for certain illnesses or mental health issues, or who have a range of other needs or preferences.
Tools like scheduling aggregators can optimize access to care by using the limited clinical resources in the most effective way. “The entry point into the health system is one of the most important,” said Kristi Henderson, DNP, NP-C, FAAN, CEO, MedExpress and Optum Virtual Care and senior vice president of the Center for Digital Health at Optum. “Data insights can match patients with the most appropriate and available clinician based on the patient’s preferences, location and clinical need, whether that be for an in-person visit or a virtual visit.”
She added that a data-driven system can determine things a patient may not be able to, like what kind of provider is best. “I may not know whether I need to see a psychiatrist, health coach, or social worker or whether I should see this clinician in a clinic, an acute care facility or if I can get my issue resolved through a virtual visit,” said Dr. Henderson. “A data-driven system removes the friction with this type of decision-making. Digital health tools informed by data also allow for more personalization. Individuals can set preferences about their healthcare to customize how, where and when they receive care thereby enhancing the experience and improving engagement.” As data-driven models and digitally-enabled health systems advance, we’ll have the ability to minimize many of the disparities related to social determinants of health, such as geographic and transportation barriers, added Dr. Henderson. “Technology enables us to address many of the inequities that too often exist in the health system.”
Nurses are important players in both informatics implementation and design
The pandemic highlighted the power of bringing informatics and nursing together, which will be just as important as we move out of the acute phase of the pandemic and into a new normal. “Every organization is looking to deliver more efficient and effective care now more than ever,” said Ms. Barey. “Another silver lining to the pandemic is how many organizations were able to rapidly leverage the triad of nursing expertise, informatics and technology and recognize this as an essential asset to thrive in the future.” She pointed out that the use of informatics is often bolstered when health systems appoint a Chief Nursing Informatics Officer (CNIO) and recommends that more institutions do this—it creates a “culture of informatics” and infuses nursing expertise into informatics design and practice.
Nurses of all backgrounds should be, and already are in many cases, driving the use of technology and data in health systems. Ms. Barey recalled when her team worked with county and state public health departments across the country during the pandemic, Washington stood out as a system that was especially savvy regarding their interoperability needs for information-sharing and setting up screening and testing. “It turned out it’s a nurse who runs it for the region, and that made a huge difference,” she said. She encourages nurses to get involved in informatics, especially in areas where nurses are already leading care but lack strong informatics, like post-acute care and public health.
Nurses have already had success as tech developers, since they are intimately aware of what’s needed as the end user, and they are often closest to the patient. Many participants we spoke with urged nurses to continue doing this—and urged institutions to support it. “It’s the pragmatic nature of the nurse, who’s been in the bunker and understands the real pain points from patients and from their colleagues in the clinical team,” said Dr. Henderson. “When you can actually bring technology and workflows that really address [the pain points] and make people’s lives easier, the solution will be adopted—you don't have to convince people. I think the same types of mindsets come when nurses are designing the solutions because it’s practical and logical, and it really resonates with the users.”
These are just a few examples but are emblematic of the ways in which nurses are innovating, supporting and implementing novel tech solutions for clinical and patient care challenges. Johnson & Johnson is committed to advocating for, elevating and empowering nurses as they transform healthcare and change human health for the better. The Accelerating Nursing, Transforming Healthcare research provides strong evidence of the impact of the nursing profession and nurses’ capacity to harness new strategies to improve healthcare. Explore our overall research findings and join us as we work to learn from the pandemic and define a progressive path forward for the nursing profession that will help drive transformative health change for all.